Despite not recommended by any international guideline, the commercial serological tests (which detect antibodies in the blood developed in response to Mycobacteria tuberculosis infection) continue to be used extensively especially tn the private health sector, with claims about accuracy often based on poor quality and grossly insufficient data. It is estimated that about 1.5 million TB suspects are subjected to serological tests every year in India at an estimated cost of 15 million USD. Results of several meta–analyses have indicated poor performance of these tests, and in 2008, an assessment by TDR (UN special programme for research and training in tropical diseases) found that none of the assays were good enough to replace conventional microbiological tests or as an add–on test to rule out tuberculosis. An updated systematic review commissioned by WHO and TDR in 2010 have re–confirmed these findings. A wrong diagnosis may mean that those with tuberculosis will not get needed therapy and may result in continued spread of the disease, or that those without tuberculosis may be subjected to possible side–effects from unnecessary treatment leading to wasted resources for the patient and consequent impact on livelihood. This has huge epiciemtological and socio–economic implications.

The WHO Expert Group and STAG–TB which reviewed this data concluded that currently available commercial serological tests provide inconsistent and imprecise estimates of sensitivity and specificity and strongly recommended that these tests should not be used for the diagnosis of pulmonary and extra–pulmonary TB (adults and children), irrespective of HIV status. On the basis of STAG–TB recommendation, WHO is due to release a negative policy — the first of its kind—on current commercial tuberculosis serodiagnostics though being cautious not to stifle research and innovation in this fteid as a more accurate serological test has the potential to become a ‘point of care’ test for diagnosing TB.

The National laboratory committee of RNTCP endorsed the WHO expert group recommendations and requested Central TB Division to disseminate the message to al! Stakeholders involved in TB control in India. (Source: DGHS)

Students of Delhi Public School presenting a beautiful skit on the occasion of the World Earth Day celebration at DPS Mathura school premises. The Event was jointly organized by Heart Care Foundation of India, Delhi Public School and Ministry of Earth Sciences.

National News

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
2. Scene/s where medical care and approach has been depicted incorrectly, or
3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to re build the image of the medical profession.

Anaemia among girls still a challenge for Rajasthan

JAIPUR: Over 80% girls in Bikaner are suffering from anaemia. This disturbing figure was revealed by a survey conducted by NGO Ajit Foundation. "There is an emergency situation in Rajasthan vis–a–vis anaemia and the BPL families are suffering the most," said Aditi Mehta, principal secretary, social justice and empowerment. Addressing a workshop on ‘Addressing anaemia’ in the city on Monday, she said calorific difference was the major reason for the problem and called for effective monitoring of the anaemia control programme. The survey’s findings state that 83.4% adolescent girls were found to be anaemic in the district with 2.98% suffering from severe, 22.2% moderate, and 58.21% mild anaemia. Though various national and state level programmes to fight against anaemia have been launched over the last decade, a large percentage of the population is still anaemic. (Source: TOI, Jun 19, 2012)

Offices inhabited by men have significantly more bacteria than women’s, according to a new study. The team, led by Scott Kelley of University of California, San Diego, identified more than 500 bacterial genera in offices in three cities, the most abundant of which tended to come from human skin or the nasal, oral, or intestinal cavities. "Humans are spending an increasing amount of time indoors, yet we know little about the diversity of bacteria and viruses where we live, work and play," said Dr Kelley. "This study provides detailed baseline information about the rich bacterial communities in typical office settings and insight into the sources of these organisms," he said. The report includes the characterization of bacterial identity and abundance in offices in New York, San Francisco, and Tucson. The researchers also found that chairs and phones had a high abundance of bacteria, while the abundance on the desktop, keyboard, and mouse were somewhat lower. This study has been published in the open access journal PLoS ONE. (Source: TOI, Jun 20, 2012)

A study in cadavers indicates that low dose CT protocols can effectively identify ureteral stones in subjects who are beyond average size. In a May 12th online paper in The Journal of Urology, Dr. D. Duane Baldwin and colleagues note that a 10.0 mSv CT exam can deliver "roughly the same radiation dose as 1,000 standard chest x–rays."

Elective delivery of uncomplicated twin pregnancies appears to lower the risk for adverse outcomes for the infants compared with standard care (allowing the pregnancy to continue), according to a study published online June 13 in BJOG. Twin pregnancies extending beyond 37 weeks are associated with elevated risk for perinatal morbidity and mortality. Studies place the safest time for delivery at 36 to 38 weeks. To assess whether elective delivery at 37 weeks lowers risk, Jodie Dodd, MBBS, PhD, from the Australian Research Centre for Health of Women and Babies, Robinson Institute, University of Adelaide, Australia, and colleagues conducted the Twins Timing of Birth Randomised Trial. (Source: Medscape)

@DeepakChopra: Spiritual intelligence doesn’t address one specific situation. It’s about finding the sacred in everyday life.

Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Life after death

It all depends on the definition of who I am? Am I my physical body, mind, intellect, ego or the soul?

In terms of computer language, my physical body is the hardware; Prana Vayu, the electricity; mind–intellect and ego, are the applications – Word, Excel and Power Point; Udana Vayu the operational software and the soul, the internal internet.

Women who are pregnant, who would like to have children in the future, or have gone through menopause should not have this procedure. If you have an intrauterine contraceptive device, you must have it removed before endometrial ablation. Non–cancerous or pre–cancerous growths cannot be treated with endometrial ablation.

Special "third–generation" blood filters can reduce the number of leukocytes in red cell or platelet components of less than 5×10, a level that reduces the risk of HLA alloimmunization and transmission of cytomegalovirus (CMV) as well as the incidence of febrile transfusion reactions. These filters contain multiple layers of synthetic non–woven fibers that selectively retain leukocytes but allow red cells and platelets to pass. Selectivity is based on cell size, surface tension characteristics, the difference in surface charge density among blood cells, and possibly, cell to cell interactions and cell activation/adhesion properties.

Because filters for red cells and filters for platelets do not use the same technology for leukocyte removal and may have strict priming and flow rate requirements, they must be used only with their intended component and only according to the manufacturer’s directions. The use of these filters at the bedside is more complex than the use of standard infusion sets. The filters are expensive and will be ineffective if improperly primed or used. Those designed only for gravity–drip infusion should not be used with infusion pumps or applied pressure.

A quality control program that measure the effectiveness of leukocyte reduction helps monitor the filter or system in place, and is especially important with bedside filtration. Routine methods of automated blood cell counting are not sensitive enough to enumerate the small numbers of leukocyte in leukocyte reduced components; the use of high volume manual counting chambers or flow cytometric procedures is preferred.

This parable is told of a farmer who owned an old mule. The mule fell into the farmer’s well. The farmer heard the mule praying or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer sympathized with the mule, but decided that neither the mule nor the well was worth the trouble of saving. Instead, he called his neighbors together, told them what had happened, and enlisted them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back, HE WOULD SHAKE IT OFF AND STEP UP!

This he did, blow after blow. "Shake it off and step up…shake it off and step up…shake it off and step up!" He repeated to encourage himself. No matter how painful the blows, or how distressing the situation seemed, the old mule fought panic and just kept right on SHAKING IT OFF AND STEPPING UP!

It wasn’t long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him actually helped him… all because of the manner in which he handled his adversity.

That’s life! If we face our problems and respond to them positively, and refuse to give in to panic, bitterness, or self–pity.

Situation: A female diabetic patient with BP of 135/85 mmHg came for evaluation. Dr Bad: Continue only the antidiabetic treatment, your BP is perfect. Dr Good: You also need to take care of your BP. It is towards higher side. Lesson: The threshold for initiating antihypertensive therapy is lower (BP of at least 1130/80 mmHg) in women with NIDDM than it is in non diabetic patients.

Mumbai: The Food and Drug Administration (FDA) has issued show–cause notices to 60 chemists in the city for irregularity in maintaining purchase and sale records of abortion drugs. The state body has also been inspecting records of doctors who directly buy medicines from the manufacturers. The FDA initiated a statewide crackdown on chemists after reports of female feticide started surfacing from Beed. The agency has so far issued notices to 282 chemists and five wholesalers across the state. Commissioner of FDA Mahesh Zagade said it was unfortunate that chemists were found flouting even basic rules like maintaining records. "Every chemist has to document the sale and purchase of certain drugs to doctors and patients. Chemists are duty–bound to keep their names and addresses. As of now, 282 chemist shops have been found flouting that rule," he said, adding that the data pertaining to doctors was still being collated. The chemists were found purchasing Medical Termination of Pregnancy (MTP) injections and pills, but not maintaining records for the same. "This obviously means the drugs were not to be used as per law," he said. The FDA has also lodged FIRs against three chemists in Beed and two chemists in Georai taluka in Beed district.

Acute urinary retention may elevate PSA levels, but the levels may decrease by 50% within 1 to 2 days following resolution. A screening PSA test should not be performed for at least two weeks following an episode of acute urinary retention.

Legal Question of the day

(Prof. M C Gupta, Advocate & Medicolegal Consultant)

Q. What is to be done when there is a conflict between a state law and a central law?

Ans.

As a general principle of law, a central law takes precedence over a state law. A state law cannot over–ride a state law.

However, if no body challenges a wrong state law, it may continue to be used. A common example is the wrong state law requirement that every physician working in the state must get registered with the SMC even though his name may be already on the state register. This is in violation of the IMC Act, 1956. But doctors (who claim themselves to be genius, law abiding intellectuals next to god in the nobility of their profession), are happy accepting the wrong state law. They are not bothered about challenging it. Nor is there association, the IMA, so interested!

Oral polio vaccine: The OPV is a live, attenuated (weakened) virus which makes the body produce antibodies against it without developing into the disease. Two types are available: monovalent that contains only one type of poliovirus and bivalent, which has both serotype 1 and serotype 3 attenuated polioviruses. Given as oral drops, multiple times, it protects not only the person who has taken the polio drops but also others living around him. Once the live vaccine virus is introduced into the body, it spreads to others through the water supply, the sewage system or food and drinking water. This way an entire household, and sometimes whole communities, can get protected as the vaccine virus helps them develop antibodies against the disease.

Injectable polio vaccine: The IPV, while highly effective, only protects the vaccinated person, and not others. It is given by injection. It is given in situations where live vaccines are contraindicated (immunocompromised status).

Mind Teaser

Read this…………………

Nurse Faith should recognize that fluid shift in an client with burn injury results from increase in the:

Embalming certificate of deceased is required by law in air/rail transportation

Embalming is the process of chemically treating a dead body developed by the ancient Egyptians of preserving a person’s body after death or delay the decomposition of the body, restore it to an acceptable physical appearance and reduce the presence and growth of bacteria to prevent foul smell as well as perfume or add fragrance to corpse.

One of the most famous embalmed corpses today is Russian communist leader Vladimir Lenin, whose embalmed corpse is on display at the Red Square mausoleum in Moscow, the corpse is very well–preserved, and should last for at least another hundred years.

The process of embalming has a very long history, dating back to the Egyptian process of mummification. Though their techniques were quite different from those used today, the effect was the same — to preserve an individual's body after death. In case of the ancient Egyptians, they believed that the spirit would return to the body after death, so it must remain in good condition. To preserve the corpses, they covered bodies in a drying chemical called natron, and then wrapped them in linen sheets.

Today, embalming is done by injecting chemicals directly into the bloodstream to preserve the corpse's appearance. The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time means up to a week

To keep the corpse in good condition for a longer period i.e. up to a month, you would use a solution made up almost entirely of formaldehyde.

There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.

There’s little hard evidence that a diet rich in tomatoes and the tomato antioxidant lycopene can ward off cancer said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. Reporting in the issue of the Journal of the National Cancer Institute, FDA experts lay out in great detail the evidence that tomato consumption is not linked to any reduction risk of tumors of the prostate, ovary, stomach and pancreas. People who manage to reduce their waistlines may also lower their risk for diabetes and heart disease.

A French study published in Diabetes Care has shown that men and women whose waistlines expanded by 3 inches or more over nine years were at increased risk of developing metabolic syndrome. In contrast, women who shed just an inch or more from their midsections had a lower risk of developing metabolic syndrome than women whose waistlines stayed the same. However, people can be normal weight based on BMI yet have a large waist, and these individuals are at risk of metabolic syndrome. Too many older people are being prescribed too many medicines or the wrong drugs. As per The Lancet, inappropriate drug use among older patients includes being prescribed drugs they don’t need, being under–prescribed medications they do need or being given inappropriate drugs. Older patients are at high–risk for having drug interactions.

A European study of 1,601 elderly outpatients in six countries found that 46 percent of them had experienced at least one significant drug interaction, and that 10 percent of these interactions were severe. Another study found that 37 percent of patients were taking drugs without their doctor’s knowledge, and six percent were taking drugs not on their doctor’s lists.

Readers Responses

Dear KK, Very philosophical editorial on Life after Death. With best wishes. Yours sincerely: Anuj Sinha.

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions